Risk factors for Preterm Premature Rupture of membranes among Pregnant Women admitted to Kawempe National Referral Hospital: A Case-Control Study

Abstract

Background: Preterm premature rupture of membranes complicates approximately 2%–4% of all pregnancies, accounting for 40% of all spontaneous preterm births and 18–20% of perinatal deaths. Globally, the prevalence of PPROM stands at approximately 8% whereas it is estimated at 9.2% in Sub-Saharan Africa and 7.5% in Uganda. However, there is paucity of recent local data on the risk factors for PPROM. The purpose of this study was to determine the risk factors for PPROM among pregnant women admitted to Kawempe National Referral Hospital. Methods: A hospital-based unmatched case-control study was conducted among 144 pregnant women i.e., 48 cases and 96 controls. A pretested interviewer-administered questionnaire was used to collect data from the participants. Binary logistic regression was used to assess the association between the independent variables and preterm premature rupture of membranes. Variables with a p value <0.2 at bivariate analysis were considered for multivariate analysis. Variables were considered statistically significant if the p value was <0.05. Goodness of fit test was applied to check whether the independent variables adequately predict the outcome. Results: At adjusted analysis, six (6) variables were independently associated with PPROM. These include age 20 to 29 years [AOR=3.3, 95% CI: 1.6-4.3, P=0.003] and 30 to 39 years [AOR=2.5, 95% CI: 1.2-3.9, P=0.014], urban residence [AOR=4.4, 95% CI: 2.5-6.4, P<0.0001], monthly income of UGX 100,000 to 190,000 [AOR=0.4, 95% CI: 0.2-0.8, P=0.034], 200,000 to 500,000 [AOR=0.3, 95% CI: 0.1-0.6, P=0.025], and more than 500,000[AOR=0.2, 95% CI: 0.08-0.5, P=0.012], multiple babies in utero [AOR=3.4, 95% CI: 2.1-8.4, P=0.001), 4 or more ANC visits [AOR=0.2, 95% CI: 0.1-0.7, P=0.002], and abnormal vaginal discharge during pregnancy[AOR=4.2, 95% CI: 2.2-9.6, P=0.002]. Conclusion: Older age, urban residence, low–income level, multiple babies in the utero, limited antenatal visits, and abnormal vaginal discharge during pregnancy were determined as risk factors for PPROM. High–income level, adequate ANC attendance, and residing in the rural setting were established as protective against PPROM. Recommendations: Access and utilization of ANC ought to be intensified to facilitate timely screening and holistic management of pregnant women. Mothers with abnormal vaginal discharge should be screened and managed optimally to prevent PPROM.